Clock ticking on full Medicaid expansion funds

In Utah, Gov. Gary Herbert has convened a work group to study options. | AP Photo

States’ largest challenges in preparing for the Medicaid expansion is updating the technical infrastructure to accommodate the influx of enrollees, adjusting to new eligibility requirements and coordinating with the health exchanges. That’s a lot of work that states already have been doing for a few years to get ready for the health law, even if they’re rejecting the coverage expansion. So a state that’s completed the bulk of the technical work and thought through how to implement the expansion could still conceivably opt in to the full year of federal funding even after Jan. 1, experts say.

Staffing could be another challenge for states that would see a huge influx of enrollees. Pennsylvania would need to hire about 2,000 people to handle Medicaid enrollment, Department of Public Welfare acting Secretary Beverly Mackereth projected.

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“[I]mplementing such a monumental increase in eligibility without having sufficient staff on board … and trained prior to implementation would only result in chaos,” Mackereth warned in a letter last week.

What could also get tricky is if a state wants to pursue an alternative path to expanding coverage, like Arkansas’s plan to cover the expansion population with private insurance through the state’s exchange. States looking to the private market to cover the new Medicaid population will have to go through a waiver process with the feds that usually lasts months.

Another complication is when, if states expand after Oct. 1, people would be able to start enrolling in health insurance exchange plans — including some people who would otherwise be eligible for the Medicaid expansion. If a state later decides to opt in to the expansion, these exchange enrollees presumably could wind up being forced to switch to Medicaid.

It’s not the biggest problem, experts say, but it does require some targeted outreach when resources will already be stretched thin.

“In theory, you’d have a little bit of a complication,” said Kip Piper, a former CMS adviser and former state Medicaid director. “You’d have to go back and track those people down in the system and say, ‘Yeah, we told you that for Jan. 1, Medicaid wasn’t there, but it is now.’”